| NPI | 1205358389 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 33754) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS041301) |
| 1223G0001X Dentist, General Practice (Licence: PA DS041301) | |
| 1223G0001X Dentist, General Practice (Licence: TX 33754) | |
| Enumeration Date | 2017-07-11 |
| Last Update Date | 2024-02-14 |